The challenges to integrating genomic findings into healthcare practice are complex and exist at multiple levels of the health care system. A collaborative, strategic, and rigorous approach to addressing the barriers and applying solutions to genomic implementation is therefore required to maximize its public health impact. The goal of the Coordinating Center at the University of Pennsylvania is to ensure the success of individual Genomic Pilot Demonstration Projects while stimulating collaboration across projects to produce and disseminate generalizable knowledge. Such knowledge can be used to sustain and expand existing efforts and to inform implementation in other clinical settings. The applicant team has extensive experience in all aspects required of the coordinating center to achieve these goals. The investigators bring insights and expertise from ongoing coordinating center leadership and collaborative genomic implementation projects; from University of Pennsylvania Centers devoted to implementation of genomics in practice, ELSI (Ethical Legal and Social Implications), statistical genetics, bioinformatics, and health communications; and from experience evaluating the efficacy and effectiveness of implementation strategies. The team proposes to use a conceptual and operational framework for collaboration borrowed from implementation science, one designed to not only assess effectiveness of implementations but also to inform their development and improve their chances of success, sustainability, and dissemination. The use of a mutually agreed-upon framework will help guide each step of the implementation process, e.g., integrating genomic findings into electronic health records, developing clinical decision support tools, and defining and measuring outcomes of implementation. The ultimate goal will be to advance the field of genomic implementation science and leverage the expertise within this and other NHGRI consortia so that the contributions of the consortia are greater than the sum of their parts.